House Bill 654
By: Representatives Campbell of the 35th, Au of the 50th, Wilkerson of the 38th, Clark of the
108th, and Westbrook of the 163rd
A BILL TO BE ENTITLED
AN ACT
To amend Article 1 of Chapter 24 of Title 33 of the Official Code of Georgia Annotated,
relating to general provisions regarding insurance, so as to prohibit insurers or third-party
administrators from conditioning the payment of any medical test or procedure or
prescription drug benefit on prior authorization; to amend Chapter 64 of Title 33 of the
Official Code of Georgia Annotated, relating to regulation and licensure of pharmacy benefit
managers, so as to prohibit pharmacy benefit managers from conditioning the payment of any
benefit for a prescription drug on prior authorization; to amend Article 2 of Chapter 34 of
Title 43 of the Official Code of Georgia Annotated, relating to medical practice, so as to
provide that a physician shall not be required to obtain any prior authorization in their
exercise of patient healthcare; to amend Part 1 of Article 1 of Chapter 18 of Title 45 of the
Official Code of Georgia Annotated, relating to state employees' health insurance plan, so
as not to condition the payment of any medical test or procedure or prescription drug benefit
on prior authorization; to provide for definitions; to provide for related matters; to provide
for an effective date and applicability; to repeal conflicting laws; and for other purposes.
BE IT ENACTED BY THE GENERAL ASSEMBLY OF GEORGIA:
SECTION 1.
Article 1 of Chapter 24 of Title 33 of the Official Code of Georgia Annotated, relating to
general provisions regarding insurance, is amended by adding a new Code section to read as
follows:
<ins>"33-24-59.34.
(a) As used in this Code section, the term 'health benefit plan' means any individual or
group plan, policy, or contract for healthcare services issued, delivered, issued for delivery,
or renewed in this state which provides major medical benefits by a healthcare corporation,
health maintenance organization, preferred provider organization, accident and sickness
insurer, fraternal benefit society, hospital service corporation, medical service corporation,
or other insurer or similar entity.
(b) Notwithstanding any provision of law to the contrary, neither an insurer nor a
third-party administrator shall condition the payment of any benefit for a medical test or
procedure or for a prescription drug upon any preapproval, prior authorization, or
precertification of any kind by an insurer if such test, procedure, or prescription drug is
otherwise covered under the health benefit plan and such medical test, procedure, or
prescription drug has been prescribed by licensed healthcare provider."
</ins> SECTION 2.
Chapter 64 of Title 33 of the Official Code of Georgia Annotated, relating to regulation and
licensure of pharmacy benefit managers, is amended by adding a new Code section to read
as follows:
<ins>"33-64-14.
(a) As used in this Code section, the term 'health benefit plan' means any individual or
group plan, policy, or contract for healthcare services issued, delivered, issued for delivery,
or renewed in this state which provides major medical benefits by a healthcare corporation,
health maintenance organization, preferred provider organization, accident and sickness
</ins>
<ins>insurer, fraternal benefit society, hospital service corporation, medical service corporation,
or other insurer or similar entity.
(b) Notwithstanding any provision of law to the contrary, a pharmacy benefit manager
shall not condition the payment of any benefit for a prescription drug upon any
preapproval, prior authorization, or precertification of any kind by such pharmacy benefit
manager, insurer, or purchaser if such prescription drug is otherwise covered under the
health benefit plan and such drug has been prescribed by a licensed healthcare provider."
</ins> SECTION 3.
Article 2 of Chapter 34 of Title 43 of the Official Code of Georgia Annotated, relating to
medical practice, is amended by adding a new Code section to read as follows:
<ins>"43-34-49.
No physician shall be required to obtain preapproval, prior authorization, or precertification
from an insurer with regard to the healthcare of his or her patients."
</ins> SECTION 4.
Part 1 of Article 1 of Chapter 18 of Title 45 of the Official Code of Georgia Annotated,
relating to state employees' health insurance plan, is amended by adding a new Code section
to read as follows:
<ins>"45-18-4.2.
(a) As used in this Code section, the term 'health benefit plan' means any individual or
group plan, policy, or contract for healthcare services issued, delivered, issued for delivery,
or renewed in this state which provides major medical benefits by a healthcare corporation,
health maintenance organization, preferred provider organization, accident and sickness
insurer, fraternal benefit society, hospital service corporation, medical service corporation,
or other insurer or similar entity.
</ins>
<ins>(b) Notwithstanding any provision of law to the contrary, the health insurance plan
established pursuant to this article shall not condition the payment of any benefit for a
medical test or procedure or for a prescription drug upon any preapproval, prior
authorization, or precertification of any kind if such test, procedure, or prescription drug
is otherwise covered under such plan and is prescribed by a licensed healthcare provider."
</ins> SECTION 5.
This Act shall become effective upon its approval by the Governor or upon its becoming law
without such approval and shall apply to all health benefit plans issued, delivered, issued for
delivery, or renewed in this state on or after July 1, 2026.
SECTION 6.
All laws and parts of laws in conflict with this Act are repealed.